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Therapeutic interventions in a rehabilitation garden may induce temporary extrovert and/or introvert behavioural changes in patients, suffering from stress-related disorders

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Patients being treated for stress-related mental illness were observed during two summer programs in order to investigate the influence of multimodal nature-based therapy in a specially designed healing garden on patient recovery. The aim was to distinguish specific qualities, patterns and/or processes during the participants' stay in the healing garden. The study is a single-case study, using participatory observation. The data were coded following an inductive research process. The results showed that patients who underwent psychotherapy were more open and contact-seeking, and carried out extrovert recreational walks. By contrast, patients who underwent physiotherapy were introverted, emotionally withdrawn and performed introvert recreational walks. Interpretation of the data suggested that treatment combined with activities in certain parts of the rehabilitation garden induced and supported different psycho-physiological processes. The mechanisms and progress of these are discussed from the theory of situated cognition, and how these processes are stimulated and supported by characteristics in the garden. Oxytocin, a hypothalamic peptide which stimulates social interaction, induces anti-stress effects and stimulates growth and healing, may hypothetically be involved in these processes.
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8Department of Work Science, Business Economics and Environmental Psychology, Swedish University of Agricultural Sciences, P.O. Box 88, SE-230 53 Alnarp, Sweden
9Department of Animal Environment and Health, Section of Anthrozoology and Applied Ethology, Swedish University of Agricultural Sciences, P.O. Box 234, SE-532 23 Skara, Sweden
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Keywords:
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UNCORRECTED PROOF
A.A. Adevi et al. Urban Forestry & Urban Greening xxx (2018) xxx-xxx
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KF JKL;P N?<K?<I G<FGC< N?F JL==<I =IFD C@E><I@E> JKI<JJI<C8K<; D<EK8C
;@JFI;<IJ :FLC; 9< KI<8K<; 8E; I<?89@C@K8K<; 98J<; FE 8:K@M@K@<J @E 8 JG<
:@8CCP ;<J@>E<; >8I;<E -<< @> 
.?< @;<8 N8J KF JK8IK =IFD 8 J8CLK8IP G<IJG<:K@M< KF JKI<E>K?<E
8E; JLGGFIK N?8K @J JKIFE> 8E; ?<8CK?P F= K?FJ< N?F 8I< 8==<:K<;
9P GIFM@;@E> K?<D JLGGFIK@M< <EM@IFED<EKJ G?PJ@:8C JF:@8C 8E; :LC
KLI8C <EM@IFED<EKJ .?< G?PJ@:8C JLGGFIK@M< <EM@IFED<EKJ K?< IFFDJ
@E K?< >8I;<E N8J ;<J@>E<; 9P K?< I<J<8I:? K<8D .?< IFFDJ :FEK8@E
I<JK=LC GC8:<J KF DFI< :?8CC<E>@E> @E 8 >I8;@<EK !I8?E <K 8C 
Fig. 1. .?@J U>LI< @CCLJKI8K<J K?< -LGGFIK@M< EM@IFED<EK .?<FIP .?< 98J< F= K?< GPI8
D@; =FCCFNJ 8E 28O@J N?@:? ;<8CJ N@K? K?< @E;@M@;L8CJ @DD<;@8K< E<<; =FI 8 JLGGFIK@M<
<EM@IFED<EK .?< ?<@>?K F= K?< GPI8D@; =FCCFNJ 8 3 8O@J N?@:? ;<8CJ N@K? K?< JKI<E>K? F=
K?< @E;@M@;L8CJ <O<:LK@M< =LE:K@FE .?< CFN<I K?< @E;@M@;L8C @J @E K?< GPI8D@; K?< CFN<I
K?< :8G8:@KP F= ?@J?<I <O<:LK@M< =LE:K@FEJ 8E; K?<I<=FI< K?< >I<8K<I K?< E<<; =FI 8 JLG
GFIK@M< <EM@IFED<EK .?< @CCLJKI8K@FE @J ,<GIF;L:<; N@K? G<ID@JJ@FE =IFD K?< 8LK?FIJ
-K@>J;FKK<I 8E; !I8?E  .?< ;<J@>E @J 98J<; FE <@>?K :?8I8:K<I@J
K@:J *<I:<@M<; -<EJFIP @D<EJ@FEJ *- !I8?E 8E; -K@>J;FKK<I 
.?<J< *-J :8E 9< I<C8K<; KF K?< GPI8D@; @E @>  8J JFD< *- GIFM@;<
DFJK JLGGFIK KF G8IK@:@G8EKJ @E K?< 9FKKFD F= K?< GPI8D@; N?@C< FK?<IJ
GIFM@;< K?< 9<JK JLGGFIK =FI G8IK@:@G8EKJ N?F 8I< ?@>?<I LG <E>KJJFE
8E; !I8?E  -K@>J;FKK<I <K 8C  .?< :LCKLI8C JLGGFIK@M< <E
M@IFED<EKJ :FEJ@JK F= 8:K@M@K@<J K?8K K8B< GC8:< @E K?< >8I;<E 8E; K?<P
N<I< 8CJF ;<J@>E<; 9P K?< I<J<8I:? K<8D .?< JF:@8C JLGGFIK@M< <EM@IFE
D<EK @J G8IKCP 89FLK K?< =<CCFN G8K@<EKJ G8IKCP 89FLK K?< K?<I8G<LK@:
K<8D NFIB@E> @E K?< >8I;<E .?< K<8D 8E F::LG8K@FE8C K?<I8G@JK 8 GJP
:?FK?<I8G@JK 8 G?PJ@FK?<I8G@JK 8 >8I;<E<I 8E; 8 C8E;J:8G< 8I:?@K<:K
F==<IJ UO<; IFLK@E<J 8E; :C<8I >L@;<C@E<J KF K?< G8IK@:@G8EKJ N?<I< I<JK
8E; I<:FM<IP @J @DGFIK8EK *áCJ;óKK@I <K 8C 
.?< 8@D F= K?< I<?89@C@K8K@FE GIF>I8D @J KF GIFDFK< ?<8CK? 8E;
JKI<E>K?<E K?< GFJJ@9@C@KP =FI G8IK@:@G8EKJ KF I<KLIE KF NFIB N@K? E<NCP
8:HL@I<; JB@CCJ I<>8I;@E> K?< KFFCJ 8E; :FG@E> JKI8K<>@<J KF LJ< @E JKI<JJ
=LC J@KL8K@FEJ !I8?E <K 8C  -8?C@E <K 8C  :K@M@K@<J 8E;
KI<8KD<EKJ 8I< :8II@<; FLK @E J<C<:K<; 8I<8J K8@CFI<; KF 9FK? K?< G8IK@:
@G8EKJ 8E; K?< B@E; F= 8:K@M@KP 8E; K8B< GC8:< FLK;FFIJ 8J N<CC 8J @E
;FFIJ 8E; @E >I<<E?FLJ<J .I<8KD<EK @E K?< CE8IG GIF>I8D :FEJ@JKJ F=
8 I<?89@C@K8K@FE G<I@F; @E >IFLGJ F= <@>?K G8IK@:@G8EKJ <OK<E;@E> FM<I
 N<<BJ JGI<8; FM<I  ?8C=;8PJ N@K? :C<8I JKIL:KLI< 8E; :FEK<EK
.?< >IFLG JK8IKJ 8K  8D N@K? 8 K<8 9I<8B =FCCFN<; 9P  D@E >L@;<;
I<C8O8K@FE =K<IN8I;J >8I;<E 8:K@M@K@<J JK8IKJ 8E; 8IFLE;  K?<
;8P <E;J G8IK =IFD >8I;<E@E> 8:K@M@K@<J G8IK@:@G8EKJ :8E :?FFJ< DFI<
JG<:@8C@Q<; 8:K@M@K@<J KNF ;8PJ 8 N<<B .L<J;8P 8E; 1<;E<J;8P GJP
:?FK?<I8GP 8E; G?PJ@FK?<I8GP K?< UIJK ;8P 98I<CP FE< ?FLI F= FE<
F= K?<J< K?<I8G@<J K?< J<:FE; ;8P 98I<CP FE< ?FLI F= K?< FK?<I K?<I
8GP "FN<M<I <8:? G8IK@:@G8EK G<I=FIDJ FE< ?FLI F= G?PJ@FK?<I8GP 8E;
FE<?FLI GJP:?FK?<I8GP <8:? N<<B *áCJ;óKK@I <K 8C 
UNCORRECTED PROOF
A.A. Adevi et al. Urban Forestry & Urban Greening xxx (2018) xxx-xxx
Fig. 2. '8G J?FN@E> ;@==<I<EK IFFDJ @E K?< >8I;<E .?< !IFM< @J K?< C<8JK ;<D8E;@E> IFFD =K<I K?8K K?< '<8;FN K?< FI<JK !8I;<E 8E; K?< 1<C:FD@E> !8I;<E =FCCFN 8 >I8;@<EK F=
9<:FD@E> DFI< 8E; DFI< ;<D8E;@E> .?< .I8;@K@FE8C LCK@M8K@FE I<8 8E; 89FM< 8CC .?< "8I;J:8G< ,FFD @J K?< DFJK ;<D8E;@E> #CCLJKI8K@FE 9P %8I@E -LE;< *<IJJFE .?< @CCLJKI8K@FE @J
,<GIF;L:<; N@K? G<ID@JJ@FE =IFD K?< 8IK@JK
CE8IG ,<?89@C@K8K@FE !8I;<E ?8J 9<<E JKL;@<; :FEK@ELFLJCP J@E:< @K
I<:<@M<; @KJ UIJK G8IK@:@G8EKJ @E  -FD< JKL;@<J ?8M< =F:LJ<; FE K?<
K?<I8GP ;<M@ 8E; &@<9<I>  *áCJ;óKK@I <K 8C  N?@C< FK?
<IJ ?8M< JKL;@<; N?<K?<I K?< ;<J@>E ?8J NFIB<; 8J @EK<E;<; .<EE>8IK
#M8IJJFE 8E; !I8?E  *áCJ;óKK@I <K 8C  ,<>8I;@E> K?< ;<
J@>E .<EE>8IK #M8IJJFE 8E; !I8?E  ;@J:FM<I<; K?8K K?< G8IK@:@
G8EKJ JFD<K@D<J DFM<; M<IP @EKIFM<IK LJ@E> JG<:@U: G8IKJ F= K?< >8I
;<E JLGGFIK@E> K?<J< 8:K@M@K@<J )E FK?<I F::8J@FEJ K?<P DFM<; @E 8E
<OKI<D< <OKIFM<IK D8EE<I N?<I< FK?<I G8IKJ F= K?< >8I;<E JLGGFIK<;
K?<J< 8:K@M@K@<J <G<E;@E> FE G<FGC<J E<<;J 8E; @EK<EK@FEJ KNF D8@E
KPG<J F= I<:I<8K@FE8C N8CBJ ?8M< 9<<E =FLE; .?<J< K8B< GC8:< @E <EM@
IFED<EKJ N@K? ;@==<I<EK :?8I8:K<I@JK@:J :FEUID@E> K?< E<<; =FI BEFNC
<;>< FE K?< I<C8K@FEJ?@G 9<KN<<E K?< ;<J@>E F= K?< >I<<E JG8:<J 8E; K?<
8:K@M@K@<J K?@J JK@DLC8K<J.<EE>8IK #M8IJJFE 8E; !I8?E  EM@
IFED<EKJ N@K? :?8I8:K<I@JK@:J I<C8K<; KF K?< ?@>?<I G8IK F= K?< GPI8D@;
J<< @>  J<<D KF JLGGFIK <OKIFM<IK N8CBJ N?@C< <EM@IFED<EKJ N@K?
:?8I8:K<I@JK@:J I<C8K<; KF K?< CFN<I G8IK F= K?< GPI8D@; J<<D KF JLG
GFIK @EKIFM<IK<; N8CBJ -K@>J;FKK<I 8E; !I8?E  .<EE>8IK #M8IJJFE
8E; !I8?E  -K@>J;FKK<I <K 8C .?< KNF KPG<J F= I<:I<8K@FE8C
N8CB@E> 8I< EFK EFK@:<; @EJK8EKCP 9LK K?@J I<JLCK N8J F9K8@E<; 8=K<I
8 J<M<EDFEK? G8IK@:@G8KFIP F9J<IM8K@FE JKL;P .<EE>8IK #M8IJJFE 8E;
!I8?E  .?<I< N8J 8 E<<; =FI J@D@C8I JKL;@<J K?8K =F:LJ<; K?< IFC<J
F= K?< KI<8KD<EK K<8D 8E; ?FN K?< K?<I8G<LK@: 8:K@M@K@<J N<I< LJ<; @E
K?< >8I;<E
2. Aim of the study
.?< GI<J<EK JKL;P N8J G<I=FID<; 8J 8 G8IK F= FE>F@E> I<J<8I:? @E
CE8IG ,<?89@C@K8K@FE !8I;<E .?< FM<I8CC 8@D N8J KF =F:LJ FE K?< I<
?89@C@K8K@FE >8I;<EJ =LE:K@FE @E K?< K?<I8G<LK@: GIF>I8D .?< JG<:@U:
F9A<:K@M< F= K?< JKL;P N8J KF F9J<IM< K?< G8IK@:@G8EKJ @E K?< I<?89@C
@K8K@FE GIF>I8D ;LI@E> 8:K@M@K@<J G<I=FID<; @E K?< >8I;<E .?< 8@D N8J
KF ;@JK@E>L@J? JG<:@U: HL8C@K@<J G8KK<IEJ 8E;FI GIF:<JJ<J ;LI@E> K?<
G8IK@:@G8EKJ JK8P @E K?< I<?89@C@K8K@FE >8I;<E .?< LE;<ICP@E> 8@D N8J
KF >8@E 8 ;<<G<I LE;<IJK8E;@E> F= N?8K D@>?K 9< ?<8CK?GIFDFK@E> 8E;
KF F9K8@E DFI< BEFNC<;>< F= K?< ?<8C@E> GIF:<JJ<J N@K?@E K?< J8CL
KF><E@: LE@KF= CE8IG ,<?89@C@K8K@FE !8I;<E :FDGI@J@E> K?< CE8IG
DF;<C K?< <EM@IFED<EK 8E; K?< K?<I8G@JKJNFIB
3. Methods
3.1. Psychotherapy and physiotherapy at Alnarp
.?< GJP:?FK?<I8GP :FEJ@JKJ F= M<I98C :FDDLE@:8K@FE 89FLK K?< G8I
K@:@G8EKJ JPDGKFDJ 8E; <OG<I@<E:<J 9<=FI< 8E; ;LI@E> K?< KI<8KD<EK
8K CE8IG .?< GJP:?FK?<I8GP 8;FGKJ 8E <:C<:K@: 8GGIF8:? GJP:?F;P
E8D@: K?<I8GP:F>E@K@M< 9<?8M@FLI K?<I8GP N@K? <DG?8J@J FE GJP
:?F;PE8D@: K?<I8GP 8E; =F:LJ<J FE JKI<E>K?<E@E> K?< G8IK@:@G8EKJ
?<8CK?P J<C= @E FI;<I KF @E:I<8J< J<C=<JK<<D 8E; <E:FLI8>< ?@D?<I KF
8::<GK 8E; 8:BEFNC<;>< ?@J?<I FNE J<C= .?< GJP:?FK?<I8G@JK LJL8CCP
I<:<@M<J K?< G8IK@:@G8EKJ @E FE< F= K?< >I<<E?FLJ<J 9LK F::8J@FE8CCP EFK
@E K?@J JKL;P K?< K?<I8GP @J :FE;L:K<; N?@C< K?< K?<I8G@JK 8E; K?< G8I
K@:@G8EK 8I< N8CB@E> 8IFLE; K?< >8I;<E !I8?E <K 8C  ;<M@ 8E;
&@<9<I>  .?< K?<I8G@JK <E;J <8:? J<JJ@FE 9P K<CC@E> K?< G8IK@:@G8EK
KF 9I@E> K?<@I I<V<:K@FEJ 8E; K?@EB@E> FLK @EKF K?< >8I;<E
.?< G?PJ@FK?<I8G@JK LJL8CCP I<:<@M<J K?< G8IK@:@G8EKJ @E K?< D8@E
9L@C;@E> "FN<M<I JFD<K@D<J EFK @E K?@J JKL;P K?< K?<I8GP @J :FE
;L:K<; FLK;FFIJ @E K?< >8I;<E .?< G8IK@:@G8EKJ ?8M< 9<<E FE J@:B
C<8M< =FI FE 8M<I8><  P<8IJ !I8?E <K 8C  CK?FL>? K?<P
?8M< 9<<E FE J@:B C<8M< =FI D8EP P<8IJ K?<P JL==<I =IFD ?@>? JKI<JJ
C<M<CJ N?@:? :8LJ< G8@E <JG<:@8CCP @E K?< J?FLC;<IJ 8E; E<:B #E 8;
;@K@FE DFJK G8IK@:@G8EKJ JL==<I =IFD GFFI 9F;P G<I:<GK@FE .?<P I<
UNCORRECTED PROOF
A.A. Adevi et al. Urban Forestry & Urban Greening xxx (2018) xxx-xxx
:<@M< 8 KI<8KD<EK K?8K G8IKCP :FEJ@JKJ F= LJL8C G?PJ@:8C K?<I8GP 8E;
G8IKCP F= 8 DF;@U<; =FID F= ,FJ<E D<K?F; 9F;PNFIB &8M<JJFE 
.?< D<K?F; @J 8 G8K?N8P KF D8B< K?< G8IK@:@G8EK 8N8I< F= 9F;P K<E
J@FEJ 8E; @KJ :FEK<EK .?< G?PJ@FK?<I8G@JK J:I<<EJ 9F;P K<EJ@FE 8E; ;<
K<ID@E<J N?<K?<I =I<< DFM<D<EK F= K?< 9I<8K? @J F::LII@E> .?< KI<8K
D<EK 8@DJ KF :I<8K< FI I<JKFI< 8E FGK@D8C JK8K< N?<I< K?< =LCC I8E><
F= GFJJ@9@C@K@<J =FI <OGI<JJ@FE 8E; 8LK?<EK@: 9<?8M@FLI <O@JK .?< HL8C
@KP F= K?< KFL:? 8 KFL:? N@K? 8 JF=K ?8E; @J 8 =8:@C@K8KFI F= 8N8I<E<JJ
8E; :?8E>< -L9KC< :?8E><J @E DLJ:C< K<EJ@FE 8E; 9I<8K?@E> 8I< EFK<;
8E; K?< ?8E;J =FCCFN 8E; I<JGFE; KF K?<J< :?8E><J .?@J K?<I8GP 8=
=<:KJ 9F;P 8N8I<E<JJ 8E; >@M<J I@J< KF <DFK@FEJ 8E; <OG<I@<E:<J K?8K
?8M< 9<<E JLGGI<JJ<; .?< G?PJ@FK?<I8G@JK 8CJF :FE:CL;<J <8:? J<JJ@FE
9P 8JB@E> K?< G8IK@:@G8EK KF 9I@E> =<<C@E>J 8E; K?FL>?KJ FLK @EKF K?< >8I
;<E ,<D8@E@E> @E N?8K<M<I @J >F@E> FE @EJ@;< PFL K8B< 8 N8CB 8E; ;F
N?8K<M<I PFL E<<; KF ;F .?@J N8P F= :FDGC<K@E> 8 K?<I8GP J<JJ@FE :8E
FECP 9< J8=<CP ;FE< @E K?< :FEK<OK F= K?< CE8IG ,<?89@C@K8K@FE !8I;<E
8::FI;@E> KF K?< K?<I8G@JK .?@J @J 9<:8LJ< K?<I< 8I< FK?<I K?<I8G@JKJ FLK
@E K?< >8I;<E 8E; 9<:8LJ< K?<I< @J =I<<;FD KF :?FFJ< 9<KN<<E JK8P@E>
8CFE< 8E; <E>8>@E> @E J<C=I<V<:K@FE 8E;FI J<<B@E> JLGGFIK @E K?< >8I
;<E ;<M@ 8E; &@<9<I>  &8M<JJFE 
3.2. Study approach
8K8 N<I< 8:HL@I<; @E K?@J JKL;P 9P LE:FE;@K@FE8CCP :FDGCP@E> N@K?
8E; F9J<IM@E> K?< G8IK@:@G8EKJ @E K?< I<?89@C@K8K@FE >8I;<E @E FI;<I
KF @;<EK@=P <JG<:@8CCP <JJ<EK@8C 8:KJ 8E; =8:KFIJ I<>8I;@E> K?< I<:FM<IP
GIF:<JJ .?< JKL;P :8E 9< M@<N<; 8J 8 HL8C@K8K@M< 8JJ<JJD<EK F= 8:K@M<
<==<:KJ F= K?< CE8IG '<K?F; .?< JKL;P :8E 9< ;<UE<; 8J 8E <K?EF
>I8G?@:8CCP @EVL<E:<; JKL;P F= 8E <OGCFI8KFIP J@E>C<:8J< E8KLI< 3@E
 N?<I< K?< IFC< F= K?< I<J<8I:?<I @J KF 9< 8 G8IK@:@G8EK F9J<IM<I
%LCC9<I> 
3.3. Preparations
.?< K?<I8G@JKJ @E CE8IG ,<?89@C@K8K@FE !8I;<E 9I@<=<; K?< G8IK@:@
G8EKJ 89FLK K?< GC8EE<; JKL;P .?< F9J<IM<I K?<E :8D< 8E; @EKIF;L:<;
?<IJ<C= 8E; <DG?8J@Q<; K?8K ?<I 8GGIF8:? N8J KF JK8P @E K?< 98:B>IFLE;
8E; EFK G8IK@:@G8K< @E K?< 8:KL8C I<?89@C@K8K@FE GIF>I8D #K N8J <O
GC8@E<; KF K?< G8IK@:@G8EKJ K?8K K?< 8@D N@K? K?< F9J<IM8K@FEJ :FE:<IE<;
K?< I<?89@C@K8K@FE GIF>I8D @E ><E<I8C *8IK@:@G8EKJ N<I< @E=FID<; 9P K?<
F9J<IM<I K?8K EF 8KK<EK@FE NFLC; 9< G8@; KF K?<@I C@=< JKFIP .?< E<LKI8C
8GGIF8:? 8;FGK<; 8CJF @EMFCM<; C@JK<E@E> KF K?< G8IK@:@G8EKJ N?<E K?<P
>8M< ;<K8@CJ F= 8 DFI< GI@M8K< E8KLI<
K?@:8C G<ID@JJ@FE =FI K?< JKL;P N8J >I8EK<; 9P K?< K?@:J FDD@K
K<< @E &LE; &/  8E; *( &LE;  .?< G8IK@:@G8EKJ I<
:<@M<; NI@KK<E 8E; FI8C @E=FID8K@FE 8E; >8M< K?<@I NI@KK<E :FEJ<EK =FI
G8IK@:@G8K@FE
3.4. Participants
)9J<IM8K@FE JKL;@<J N<I< :FE;L:K<; LE;<I KNF ;@==<I<EK I<?89@C@K8
K@FE GIF>I8DJ K?8K KFFB GC8:< @E CE8IG ,<?89@C@K8K@FE !8I;<E =FI KNF
:FEJ<:LK@M< JLDD<IJ .?< KNF >IFLGJ :FEJ@JK<; F=  G8IK@:@G8EKJ @E KF
K8C FE< D8E 8E;  NFD<E LI@E> K?< UIJK JLDD<I F9J<IM8K@FE G<
I@F; # K?<I< N<I< UM< NFD<E 8E; @E@K@8CCP 8CJF FE< D8C< G8IK@:@G8K@E>
.?< C8KK<I ;@J:FEK@EL<; K?< I<?89@C@K8K@FE 8K 8E <8ICP JK8>< LI@E> K?<
=FCCFN@E> JLDD<I F9J<IM8K@FE G<I@F; ## K?<I< N<I< J<M<E NFD<E 8E;
FE< D8E .?< G8IK@:@G8EKJ :FEJ@JK<; F= G<FGC< 8><;  P<8IJ N?F
?8; 9<<E FE J@:BC<8M< =FI 8 G<I@F; F=  P<8IJ 8CC ;@8>EFJ<; N@K?
JKI<JJI<C8K<; D<EK8C ;@JFI;<IJ :C8JJ@U:8K@FE  8::FI;@E> KF K?< #EK<I
E8K@FE8C C8JJ@U:8K@FE F= @J<8J<J # 
.?< 8M<I8>< 8>< F= K?< G8IK@:@G8EKJ @E K?< GIF>I8D N8J  P<8IJ
.?< 8M<I8>< ;LI8K@FE F= J@:B C<8M< N8J  P<8IJ 9<=FI< K?< G8IK@:@G8EK
JK8IK<; KI<8KD<EK @E CE8IG 9FLK  F= G8IK@:@G8EKJ @E K?@J I<?89@C@
K8K@FE GIF>I8D N<I< NFD<E
3.5. Limitations of the study
.?< ;8K8 :FCC<:K<; N<I< 8E8CPJ<; 9P K?< F9J<IM<I KF ;@J:FM<I GFJJ@
9C< G8KK<IEJ )9J<IM8K@FEJ N<I< D8;< FM<I 8 KFK8C F=  N<<BJ N@K? FE<
KF KNF ;8PJ F= F9J<IM8K@FE G<I N<<B .?< I<8JFE =FI EFK F9J<IM@E> 8CC
;8PJ ;LI@E> K?< I<?89@C@K8K@FE GIF>I8D N8J 9<:8LJ< K?< G8KK<IEJ ;@J:FM
<I<; :FE:<IE@E> 9<?8M@FLI8C :?8E><J @E K?< G8IK@:@G8EKJ N<I< M<IP :C<8I
8=K<I JFD< N<<BJ ;LI@E> F9J<IM8K@FE G<I@F; #  ;<:@J@FE N8J K8B<E KF
FECP D8B< F9J<IM8K@FEJ ;LI@E> ;8PJ N?<E K?< GJP:?FK?<I8G@JK 8E; K?<
G?PJ@FK?<I8G@JK ?8; 8GGF@EKD<EKJ N@K? K?< G8IK@:@G8EKJ .?@J C<; KF 8
G8IK@:LC8I =F:LJ FE K?<J< F::8J@FEJ @E K?< I<D8@E@E> N<<BJ N@K?@E K?<
UIJK GIF>I8D 8E; FE K?< J8D< KPG< F= F::8J@FEJ ;LI@E> F9J<IM8K@FE G<
I@F; ## K?< =FCCFN@E> P<8I .?@J I<JLCK<; @E 8 KFK8C F=  F9J<IM8K@FE ;8PJ
;LI@E> K?< UIJK P<8I 8E;  F9J<IM8K@FE ;8PJ ;LI@E> K?< =FCCFN@E> P<8I
.?<I< N<I< EF J@>E@=@:8EK ;@==<I<E:<J @E N<8K?<I :FE;@K@FEJ 9<KN<<E K?<
>IFLGJ 8E; 9<KN<<E K?< P<8IJ
3.6. Observations
.?< D<K?F; @J F9J<IM8K@FE N@K? G8JJ@M< G8IK@:@G8K@FE IPD8E
 .?< I<>@JKI8K@FEJ N<I< GC8EE<; @E E8KLI8C J@KL8K@FEJ N@K? ;@J
:I<<K EFEI<8:K@M< F9J<IM8K@FE 8E; N@K? FG<E <E;<; E8II8K@M< I<GFIK@E>
<EQ@E 8E; &@E:FCE  .?< F9J<IM<I @E 8CC :8J<J N8J K?< UIJK 8L
K?FI 8:? ;8P J?< N8J ;I<JJ<; @E >8I;<E@E> :CFK?<J@E K?< =FID F= 8
9CL< NFIB FM<I8CC 8E; J?< NFIB<; N@K? <M<IP;8P K8JBJ JL:? 8J N8K<I@E>
N<<;@E> G@:B@E> 9<II@<J GC8EK@E> <K: 8=K<I ;@J:LJJ@FEJ N@K? K?< >8I
;<E<I .?< @EK<EK@FE N8J KF EFK @EK<I=<I< FI @EK<IILGK K?< G8IK@:@G8EKJ @E
K?<@I =I8>@C< I<:FM<IP GIF:<JJ<J .?< F9J<IM<IJ BEFNC<;>< N?<E 9<>@E
E@E> K?< F9J<IM8K@FE GIF:<JJ N8J 98J<; GI@D8I@CP FE @E=FID8K@FE >8K?
<I<; K?IFL>? @E;<GK? @EK<IM@<NJ N@K? K?< JK8W NFIB@E> 8K CE8IG ,<?8
9@C@K8K@FE !8I;<E 8E; FE @EK<IM@<NJ :FE;L:K<; N@K? =FID<I G8IK@:@G8EKJ
;<M@ 8E; &@<9<I>  ;<M@ 8E; 'åIK<EJJFE 
3.7. Observation notes and analysis
.?< F9J<IM8K@FEJ N<I< :8II@<; FLK KI8EJG8I<EKCP @E :FEJLCK8K@FE N@K?
JK8W 8E; G8IK@:@G8EKJ 8E; N<I< ;F:LD<EK<; @E K?< =FID F= D<DFJ NI@K
K<E 8=K<I <8:? F9J<IM8K@FE .?<I< N8J EF K<DGC8K< =FI K?<J< F9J<IM8
K@FEJ K?<P 9<>8E N@K? 8E FG<E D@E; .?< F9J<IM<IJ 98:B>IFLE; 8J 8
9<?8M@FLI@JK N@K?@E K?< GJP:?FCF>@:8C U<C; N8J I<V<:K<; @E N?8K J?<
N8J <JG<:@8CCP @EK<I<JK<; @E F9J<IM@E> 8:@8C <OGI<JJ@FEJ 9F;P C8E
>L8>< 8E; @EK<IG<IJFE8C @EK<I8:K@FEJ 8KKI8:K<; 8KK<EK@FE 8E; N<I< F=
J@>E@=@:8EK @EK<I<JK 8:? G8IK@:@G8EK 8E; JK8W D<D9<I N8J 8CCF:8K<; 8
ELD9<I N@K?@E 8 :F;@E> JPJK<D
.?< G8IK@:@G8EKJ9<?8M@FLI 9F;P C8E>L8>< 8E; 8:K@FEJ N<I<
>IFLG<; 8E; K?<D8K@J<; 8J N8J K?<@I :?F@:< F= NFI;J +L8C@K8K@M<
8E8CPJ@J @EMFCM<J <E:F;@E> D8K<I@8C 8E; :I<8K@E> @EEFM8K@M< ;<J@>EJ 8E;
:8K<>FI@<J 98J<; FE K?< D8K<I@8C 8:BD8E  OGI<JJ@FE F= K?<
K?<D<J 8E; GIF:<JJ ;<J:I@GK@FE N<I< :8II@<; FLK LJ@E> FG<E 8J N<CC 8J
J<C<:K@M< :F;@E> :8K<>FI@Q8K@FE 8E; K?<D8K@J8K@FE .?< GIF:<JJ 8CJF @E
MFCM<; K?<FI<K@:8C J8DGC@E> IPD8E  .?< ;8K8 N<I< :F;<; =FC
CFN@E> 8E @E;L:K@M< I<J<8I:? GIF:<JJ <EQ@E 8E; &@E:FCE  N?<I<
K?< I<J<8I:?<IJ JFL>?K KF ;<M<CFG <OGC8E8KFIP 8E; K?<FI<K@:8C B<P :FE
:<GKJ 8E; KF UE; :FEE<:K@FEJ 8DFE> K?<D @E FI;<I KF ;<M<CFG 8 K?<FIP
98J<; FE K?< I<JLCKJ 1@K? 8E FG<E D@E; 8KK<DGKJ N<I< D8;< KF @;<EK@=P
9FK? <O@JK@E> 8E; E<N @EEFM8K@M< :FE:<GKJ KF @;<EK@=P K?< JKIL:KLI< 8E;
D<8E@E> @E K?< D8K<I@8C .?IFL>? K?< 8E8CPJ@J GIF:<JJ @EMFCM@E> :F;@E>
:8K<>FI@Q8K@FE 8E; K?<D8K@J8K@FE B<P :FE:<GKJ N<I< @;<EK@U<; 8E; I<
JLCK<; @E ;<C@D@K<; K?<D<J N?@:? 8I< GI<J<EK<; @E K?< ,<JLCKJ J<:K@FE
UNCORRECTED PROOF
A.A. Adevi et al. Urban Forestry & Urban Greening xxx (2018) xxx-xxx
CC 8LK?FIJ :FE;L:K<; K?<@I FNE 8E8CPJ@J F= K?< :FCC<:K<; D8K<I@8C
=K<I K?8K K?< I<JLCK N8J ;@J:LJJ<; LEK@C 8CC 8LK?FIJ I<8:?<; :FEJ<EJLJ
1?<E 8CC 8LK?FIJ F= K?@J G8G<I ;@J:LJJ<; K?< 8E8CPJ<J I<>8I;@E> K?< G8I
K@:@G8EKJ KF><K?<I @K 9<:8D< M<IP :C<8I ?FN F9J<IM<; <M<EKJ 8E; 9<?8M
@FLI8C :?8E><J N<I< 8JJF:@8K<; .?<J< <M<EKJ N<I< 8E8CPJ<; JPJK<D8K@
:8CCP =FI M8I@FLJ K?<D<J
4. Results
LI@E> K?< UIJK N<<BJ F= K?< I<?89@C@K8K@FE GIF>I8D K?< UIJK P<8I
K?< F9J<IM<I :?FJ< KF F9K8@E @E=FID8K@FE =IFD K?< G?PJ@FK?<I8G@JK 8E;
K?< GJP:?FK?<I8G@JK :FE:<IE@E> <8:? G8IK@:@G8EKJ DFF; 9<=FI< 8E; 8=
K<I <8:? J<JJ@FE "FN<M<I K?< F9J<IM<I K?<E I<8C@Q<; K?8K N?8K<M<I K?<
DFF; F= K?< G8IK@:@G8EK J8;E<JJ ?8GG@E<JJ =ILJKI8K@FE K?@J ;@; EFK
@EVL<E:< K?<@I 9<?8M@FLI 8=K<I K?< M8I@FLJ J<JJ@FEJ GJP:?FK?<I8GP FI
G?PJ@FK?<I8GP @E :FEE<:K@FE N@K? <C<D<EKJ @;<EK@U<; 8J 9<@E> @EK<I
<JK@E> KF DFE@KFI ;LI@E> K?< I<JK F= K?< GIF>I8D =K<I :FCC<:K@E> K?@J
B@E; F= @E=FID8K@FE @K N8J ;@J:FM<I<; K?<I< N<I< EF @EK<I<JK@E> C@EBJ
9<KN<<E K?< :LII<EK JK8K< F= D@E; 8E; K?< JL9J<HL<EK :FLIJ< F= <M<EKJ
FI 9<?8M@FLI
=K<I FECP KNF N<<BJ F= F9J<IM8K@FEJ ;LI@E> K?< UIJK P<8I 8 :C<8I
G8KK<IE N8J I<M<8C<; 8E; @K N8J ;<:@;<; KF JKL;P K?@J @E >I<8K ;<K8@C
9<:8LJ< F= @KJ I<C<M8E:< 8E; :FEE<:K@FEJ N@K? ?<8C@E>I<:FM<IP =8:
KFIJ .?LJ K?< =F:LJ F= K?< F9J<IM8K@FEJ J?@=K<; =IFD ><E<I8C F9J<IM8
K@FEJ KF JFD< JG<:@8C J@KL8K@FEJ 8E; <M<EKJ 8=K<I K?< KNF B@E;J F= K?<I
8GP K?< GJP:?FK?<I8GP 8E; K?< G?PJ@FK?<I8GP J<JJ@FEJ @E :FD9@E8
K@FE N@K? :FEK8:K N@K? K?< JLIIFLE;@E> >8I;<E LI@E> K?< =FCCFN@E>
P<8I K?< F9J<IM8K@FEJ JK8IK<; KF =F:LJ ;@I<:KCP FE K?<J< J@KL8K@FEJ 8E;
<M<EKJ "<E:< DFJK F9J<IM8K@FEJ :FE:<IE<; K?< @EK<I8:K@FE 9<KN<<E
GJP:?FK?<I8GP 8E; K?< >8I;<E FI G?PJ@FK?<I8GP 8E; K?< >8I;<E  @> 
4.1. Observed behaviour after the psychotherapy session
4.1.1. Contact seeking
.?< G8IK@:@G8EKJ J?FN<; 8 ;<J@I< =FI FLK>F@E> @EMFCM<D<EK <O
GI<JJ<; K?IFL>? >I<8K FG<EE<JJ 8E; <8JP 8::<JJ@9@C@KP 8 N@CC@E>E<JJ KF
@EK<I8:K N@K? FK?<IJ 8E; KF ><K @E :FEK8:K N@K? FK?<IJ .?<P N<I< @E
;<<; 8EO@FLJ KF ><K @EKF :FEK8:K <JG<:@8CCP 8 E<<; =FI ?LD8E :FEK8:K
.?@J 9<?8M@FLI N8J EFK F9J<IM<; @E FK?<I J@KL8K@FEJ @E K?< >8I;<E 8E;
N8J ;@JGC8P<; 8J 8E <OKI8FI;@E8IP @DD<;@8K< <M<EK 8J @= JFD<FE< ?8;
V@GG<; 8 JN@K:?  @> 
4.1.2. Talking
.?< F9J<IM<I EFK@:<; K?8K G8IK@:@G8EKJ 8CN8PJ KI@<; KF @E@K@8K< 8E;
:FEK@EL< M<I98C :FDDLE@:8K@FE N@K? JFD<FE< .?@J E<<; =FI K8CB@E>
N8J F9M@FLJ N?<K?<I 8 G<IJFE :8I<>@M<I 8EFK?<I G8IK@:@G8EK K?< F9
J<IM<I N8J 8::<JJ@9C< J<<D<; KF ;<K<ID@E< N?F K?< G8IK@:@G8EK :?FJ< KF
K8CB N@K? "<E:< @K 8GG<8I<; KF 9< @II<C<M8EK N?<K?<I K?< G<IJFE :?FJ<E
N8J FE< K?< G8IK@:@G8EK LJL8CCP K8CB<; N@K? -L:? 8E F9M@FLJ E<<; =FI
K8CB@E> N8J EFK F9J<IM<; 8K 8CC @E :FEE<:K@FE N@K? 8EP FK?<I J@KL8K@FE
.?< JL9A<:K F= K?< :FEM<IJ8K@FE ;@; EFK J<<D KF 9< F= >I<8K @DGFIK8E:<
K?< D8@E =8:KFI N8J K?8K K?< ;@8CF>L< :FLC; JK8IK 8E; :FEK@EL< .?< K8CB
N8J LE=F:LJ<; 8E; K?< G8IK@:@G8EK @E HL<JK@FE ;@; EFK J<<D KF 9< G8IK@:
LC8ICP J8; FI ?8GGP )E< F9J<IM8K@FE N8J K?8K ;LI@E> F9J<IM8K@FE G<I@F;
# K?< JL9A<:K DFJKCP :FE:<IE<; GC8EKI<C8K<; HL<JK@FEJ ;@I<:K<; D8@ECP
8K K?< >8I;<E<I 8E; K?< <;L:8KFI FI <M<E K?< F9J<IM<I N?@C< ;LI@E> F9
J<IM8K@FE G<I@F; ## K?< JL9A<:K DFJKCP :FE:<IE<; =FF;I<C8K<; HL<JK@FEJ
@K8K@FE =IFD K?< F9J<IM8K@FE EFK<J
-?< N<EK ;@I<:KCP KF 2 8 G<IJFE @E K?< JK8W @E K?< U<C; 8E;
F? ?FN J?< K8CB<; 8E; 8K K?< J8D< K@D< K8B@E> G8IK @E K?< 8:
Fig. 3. '8G J?FN@E> K?< IFFDJ @E K?< >8I;<E K?8K K?< G8IK@:@G8EKJ CFFB LG N?<E K?<P 8I< <OKIFM<IK<; .?< <EKI8E:< KF K?< D8@E 9L@C;@E> :IFJJIF8;J K?< ;@==<I<EK :LCK@M8K@FE 8I<8J 8E;
K?< "8I;J:8G< IFFD #CCLJKI8K@FE 9P %8I@E -LE;< *<IJJFE .?< @CCLJKI8K@FE @J ,<GIF;L:<; N@K? G<ID@JJ@FE =IFD K?< 8IK@JK
UNCORRECTED PROOF
A.A. Adevi et al. Urban Forestry & Urban Greening xxx (2018) xxx-xxx
Fig. 4. IFJJIF8;J @E K?< 1<C:FD@E> >8I;<E *?FKF C@J89<K? MFE JJ<E .?< G?FKF>I8
G?P @J ,<GIF;L:<; N@K? G<ID@JJ@FE =IFD K?< G?FKF>I8G?<I
Fig. 5. ,8@J<; 9<;J @E K?< "8I;J:8G< IFFD *?FKF *8KI@B !I8?E .?< G?FKF>I8G?P @J ,<
GIF;L:<; N@K? G<ID@JJ@FE =IFD K?< G?FKF>I8G?<I
K@M@KP ;<8C@E> N@K? VFN<IJ -?< :?8E><; G8IKE<IJ KF K8CB N@K?
:FEK@ELFLJCP
4.1.3. Hunger
"LE><I N8J F9J<IM<; KF 8 C8I>< <OK<EK .?<I< J<<D<; KF 9< JL;;<E
?LE><I =<<C@E>J F= 9<@E> 8=K<I N?8K<M<I KF <8K 8J FE< G8IK@:@G8EK <O
GI<JJ<; @K #E F9J<IM8K@FE G<I@F; ## @K N8J :C<8I K?8K K?<J< =<<C@E>J ;@;
EFK ?8M< KF :FE:<IE =FF; 9LK :FLC; :FE:<IE FK?<I K?@E>J I<C8K<; KF K?<
DFLK? JL:? 8J :@>8I<KK<J 8E; 8 JL;;<E E<<; KF UE; 8 G8JK@CC<CFQ<E><
@E 8 GF:B<K @E 8 :FLGC< F= :8J<J .?@J =<<C@E> G<:B@J? N8J FECP EFK@:<;
Fig. 6. .?< >I<<E?FLJ< 8K K?< <EKI8E:< KF K?< D8@E 9L@C;@E> *?FKF *8KI@B !I8?E .?<
G?FKF>I8G?P @J ,<GIF;L:<; N@K? G<ID@JJ@FE =IFD K?< G?FKF>I8G?<I
Fig. 7. .?< K<II8:< =8:@E> K?< KI8;@K@FE8C B@K:?<E >8I;<E *?FKF *8KI@B !I8?E .?< G?F
KF>I8G?P @J ,<GIF;L:<; N@K? G<ID@JJ@FE =IFD K?< G?FKF>I8G?<I
8=K<I K?< GJP:?FK?<I8GP J<JJ@FE  =FID F= 9<@E> C<JJ 8==<:K@M< N8J @E;@
:8K<; 8=K<I K?@J J<JJ@FE
@K8K@FE =IFD K?< F9J<IM8K@FE EFK<J
.8CB<; ;@I<:KCP N@K? K?< FK?<I G8IK@:@G8EKJ ;LI@E> ?<I JDFB< #K
N8J F9M@FLJ K?8K J?< JFL>?K FLK FK?<IJ =FI K8CB@E>
4.2. Observed behaviour after the physiotherapy session
4.2.1. Being self-absorbed and friendly
.?< G8IK@:@G8EKJ J?FN<; @EN8I;KLIE@E> 9<?8M@FLI 8E; N<I< @E N?8K
D8P 9< G<I:<@M<; 8J 8 I<V<:K@M< 8E; K?FL>?K=LC @EE<I JK8K< .?<P N<I<
8J 89JFI9<; @E K?<@I K?FL>?KJ 8J JFD<9F;P J<C=:<EKI<; K K?< J8D<
K@D< K?<P 8:K<; @E 8 EFK@:<89CP =I@<E;CP N8P  @> 
UNCORRECTED PROOF
A.A. Adevi et al. Urban Forestry & Urban Greening xxx (2018) xxx-xxx
Fig. 8. '8G J?FN@E> K?< IFFDJ @E K?< >8I;<E K?8K K?< G8IK@:@G8EKJ CFFB LG N?<E K?<P 8I< @EKIFM<IK<; .?< 1<C:FD@E> !8I;<E K?< FI<JK !8I;<E .?< '<8;FN 8E; K?< !IFM< #CCLJKI8K@FE
9P %8I@E -LE;< *<IJJFE .?< @CCLJKI8K@FE @J ,<GIF;L:<; N@K? G<ID@JJ@FE =IFD K?< 8IK@JK
4.2.2. An introspective gaze
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;@==<I<EK B@E; F= <OGI<JJ@FE N?@:? :8E 9< ;<J:I@9<; 8J J<C=89JFI9<;
N@K? 8E @EKIFJG<:K@M< >8Q< 'FI< GI<:@J<CP @K :8E 9< ;<J:I@9<; 8J 8 ?8QP
8E; M8:8EK EFE:C<8I >8Q< 8E 89J<EK <OGI<JJ@FE @E K?< =8:< GI<F::L
G8K@FE N@K? ?@D?<IJ<C= @E K?8K DFD<EK 8:K@E> 8J K?FL>? @E 8 9L99C<
)=K<E G8IK@:@G8EKJ ?8; K<8IJ @E K?<@I <P<J 8E; :FLC; 9< ;<J:I@9<; 8J ?8M
@E> >FE< KF 8 :FDGC<K<CP ;@==<I<EK JK8K< F= D@E; 8J @= 8 E<N :?8EE<C
?8; FG<E<; KF <OG<I@<E:<
4.2.3. Calm and collected body language
.?< G8IK@:@G8EKJ J<<D<; KF 9< @E 8E @EN8I; JK8K< F= D@E; N@K? :C<8I
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8K K?<@I J?F<J :8CD 8E; :FCC<:K<; N@K? JK<8;P JK<GJ FLK =IFD K?< J<J
J@FEJ  @> 
4.2.4. A friendly silent approach
=K<I K?< J<JJ@FEJ K?< G8IK@:@G8EKJ N<I< F9J<IM<; KF <EK<I @EKF
=I@<E;CP 9LK K8:@KLIE 9<?8M@FLI .?@J =I@<E;C@E<JJ N8J I<D8IB89CP 8G
G8I<EK F=K<E <OGI<JJ<; K?IFL>? D<JJ8><J ;<C@M<I<; 9FK? M@8 K?< <P<J
8E; K?< DFLK?  =I@<E;CP ;<D<8EFLI N8J 8CN8PJ :FDDLE@:8K<; JFD<
K@D<J N@K?FLK M<I98C :FDDLE@:8K@FE FI N@K? ALJK 8 =<N NFI;J .?< G8I
K@:@G8EKJ E<M<I JK8IK<; 8 :FEM<IJ8K@FE @DD<;@8K<CP 8=K<I 8 G?PJ@FK?<I8GP
J<JJ@FE .?<P <@K?<I J8@; 8 =<N =I@<E;CP GFC@K< G?I8J<J :FDDLE@:8K<; @E
8 :8CD 8E; I<C8O<; N8P FI FECP >8M< 8 N8ID JD@C< 8 EF; #K 8GG<8I<;
K?8K K?<P :FLC; EFK G8JJ 9P N@K?FLK J8P@E> JFD<K?@E> E@:< <M<E ALJK 8
:FLGC< F= NFI;J I@<E;C@E<JJ N8J J?FNE ;@I<:KCP 8=K<IN8I;J FI D@ELK<J
C8K<I 8=K<I K?<P ?8; <D<I><; =IFD K?< 9L99C<K?<P 8CC F::LG@<;@D
D<;@8K<CP 8=K<I G?PJ@FK?<I8GP J<JJ@FEJ
.?< F9J<IM<I N8J KI<8K<; ;@==<I<EKCP N?<E K?< G8IK@:@G8EKJ :8D<
FLK =IFD 8 G?PJ@FK?<I8GP J<JJ@FE :FDG8I<; N@K? FK?<IN@J< 1?@C< K?<
Fig. 9. *?FKF>I8G?P J?FN@E> 8 G8K? @E K?< C<JJ ;<D8E;@E> 1<C:FD@E> !8I;<E *?FKF
C@J89<K? MFE JJ<E .?< G?FKF>I8G?P @J ,<GIF;L:<; N@K? G<ID@JJ@FE =IFD K?< G?FKF>I8
G?<I
8GGIF8:? F= K?< F9J<IM<I N8J KF 8MF@; ;@I<:K :FEK8:K N@K? K?< G8IK@:@
G8EKJ @E K?< =FID F= <> JK8IK@E> 8 :FEM<IJ8K@FE @K N8J DFI< LJL8C K?8E
LELJL8C =FI K?< G8IK@:@G8EKJ KF 9<>@E K8CB@E> <> 9P ALJK J8P@E> 8 =<N
=I@<E;CP NFI;J .?@J ?8GG<E<; N?<E<M<I K?<P <E:FLEK<I<; K?< F9J<IM<I
@E K?< >8I;<E 8E; JFD<K@D<J @E;FFIJ 8J N<CC #K N8J K?<@I N8P F= :FD
DLE@:8K@E> K?8K N8J ;@==<I<EK =K<I G?PJ@FK?<I8GP K?< G8IK@:@G8EKJ 8C
N8PJ J<<D<; KF 9< I<D8IB89CP :F?<I<EK J<C=:FEKIFCC<; LJ<; =<N NFI;J
8E; J?FN<; =I@<E;C@E<JJ E LE;FL9K<; :8CDE<JJ F= 9<?8M@FLI N8J 8CJF
;<DFEJKI8K<; LI@E> F9J<IM8K@FE G<I@F; # K?@J =I@<E;C@E<JJ N8J D8@ECP
<OGI<JJ<; K?IFL>? :FDGC@D<EKJ F=K<E GC8EKI<C8K<; JL:? 8J 3FL 8I<
;F@E> K?8K C@B< 8 I<8C >8I;<E<I
UNCORRECTED PROOF
A.A. Adevi et al. Urban Forestry & Urban Greening xxx (2018) xxx-xxx
Fig. 10.  G@:KLI< =IFD K?< >IFM< KFN8I;J K?< KI<< C@E< 8K K?< D<8;FN *?FKF C@J89<K?
MFE JJ<E .?< G?FKF>I8G?P @J ,<GIF;L:<; N@K? G<ID@JJ@FE =IFD K?< G?FKF>I8G?<I
Fig. 11.  E8IIFN G8K? @E K?< N<C:FD@E> >8I;<E N@K? GC8EKJ K?8K K?< G8IK@:@G8EKJ C@B< KF
JKIFB< 8E; :8I<JJ *?FKF C@J89<K? MFE JJ<E .?< G?FKF>I8G?P @J ,<GIF;L:<; N@K? G<I
D@JJ@FE =IFD K?< G?FKF>I8G?<I
4.2.5. Picking behaviour
1?<E K?< @EKIFJG<:K@M< >8Q< 8E; K?< 9L99C<N<I< FM<I D@E
8=K<I K?< G?PJ@FK?<I8GP J<JJ@FE @K N8J F=K<E F9J<IM<; K?8K K?< G8I
K@:@G8EKJ <OG<I@<E:<; 8 E<<; KF G@:B FI KFL:? JFD< M<><K8K@FE 1?8K
K?< G8IK@:@G8EKJ 8:KL8CCP :?FJ< KF G@:B ;@==<I<; VFN<IJ C<KKL:< ?<I9J
9<II@<J =IL@K <K: )E< G8IK@:@G8EK 8:KL8CCP ?8; ?<I FNE <OGI<JJ@FE =FI
Fig. 12. 1@C; IFJ<J 8E; N@C; JKI8N9<II@<J @E K?< FI<JK !8I;<E *?FKF C@J89<K? MFE J
J<E .?< G?FKF>I8G?P @J ,<GIF;L:<; N@K? G<ID@JJ@FE =IFD K?< G?FKF>I8G?<I
K?@J J?< I<=<II<; KF ?<I G@:B@E> 9<?8M@FLI 8J G<KK@E> ?<I GC8EK 98
9@<J@E K?< >I<<E?FLJ< N?<I< J?< F=K<E N<EK 8=K<I K?< G?PJ@FK?<I
8GP J<JJ@FEJ #K N8J 8CJF F9J<IM<; K?8K K?<I< N8J 8 ;@==<I<E:< 9<KN<<E
J?FIKK<ID G@:B@E> N?@:? F::LII<; JGFEK8E<FLJCP 8E; M<IP JFFE 8=K<I
K?< G?PJ@FK?<I8GP J<JJ@FE 8E; CFE>K<ID G@:B@E> K@D< N8J <JG<:@8CCP
J<K 8J@;< 8E; :FDDLE@:8K<; 8J >F@E> FW KF G@:B 9<II@<J FI =IL@K LI@E>
F9J<IM8K@FE G<I@F; ## K?< G8IK@:@G8EKJ N<I< F9J<IM<; KF 8CJF KFL:? K?<
M<><K8K@FE @E 8;;@K@FE KF G@:B@E>
4.2.6. Imitating behaviour
#E :FEE<:K@FE N@K? ;<DFEJKI8K@E> =I@<E;C@E<JJ K?< G8IK@:@G8EKJ 8CJF
J?FN<; 8 K<E;<E:P =FI 9<@E> @EJG@I<; 9P N?8K K?< F9J<IM<I ;@; )E
K?<J< F::8J@FEJ K?< 9<?8M@FLI JFD<K@D<J 8GG<8I<; KF 9< <O8>><I8K<;
.?@J N8J :C<8ICP J?FNE ;LI@E> F9J<IM8K@FE G<I@F; # 9LK EFK 8J :C<8ICP
;LI@E> G<I@F; ## #= K?< F9J<IM<I <> G@:B<; C8M<E;<I KF GLK FE K?<
K89C< K?< G8IK@:@G8EKJ 9<>8E KF G@:B K?< J8D< GC8EKJ FI @= K?< F9J<IM<I
K<JK<; J<8K@E> GC8:<J N@K?@E <8:? >8I;<E IFFD K?<E K?< G8IK@:@G8EKJ
8CJF J?FN<; @EK<I<JK @E ;F@E> K?< J8D< <@K?<I @E ;@I<:K :FEALE:K@FE N@K?
K?8K J@KL8K@FE FI DFD<EK FI C8K<I
@K8K@FEJ =IFD K?< F9J<IM8K@FE EFK<J
1@K? JCFN =<<K N@K? 8 J?L=V@E> >8@K J?< N<EK 8IFLE; @E K?< G8K?
N8PJ 8E; B<GK ?<IJ<C= 8IFLE; K?< M@:@E@KP F= K?< G?PJ@FK?<I8
G@JK -?< 9<EK =8I ;FNE G@:B<; JD<CC<; 8E; CFFB<; @EN8I;J LE
I<8:?89C< @E 8 N8P =K<I K?8K FLK KF K?< ?<I9 9<;J N?<I< ?<I
KFL:?@E> F= K?< M<><K8K@FE DFJKCP CFFB<; 8J @= J?< N<I< GFC@J?@E>
K?< C<8M<J K?< ?<;>< K?< VFN<I G<K8CJ
UNCORRECTED PROOF
A.A. Adevi et al. Urban Forestry & Urban Greening xxx (2018) xxx-xxx
.?< J<:FE; P<8I K?< G?PJ@FK?<I8G@JK 8E; K?< GJP:?FK?<I8G@JK N<EK
FE ?FC@;8P ;LI@E> N<<B  F= K?< F9J<IM8K@FE G<I@F; .?< 89FM<D<E
K@FE<; 9<?8M@FLIJ N<I< EFK F9J<IM<; ;LI@E> K?8K K@D< .?<I< N8J 8 :C<8I
:FEKI8JK KF K?< <8IC@<I N<<BJ F= F9J<IM<; 9<?8M@FLIJ #E K?< 89J<E:< F=
<@K?<I G?PJ@FK?<I8GP FI GJP:?FK?<I8GP K?< G8IK@:@G8EKJ 9<?8M<; 8E;
=LE:K@FE<; 8J K?<P LJ<; KF ;F 9<=FI< K?<P JK8IK<; K?< K?<I8GP J<JJ@FEJ
#E K?< =FCCFN@E> N<<B N?<E K?< G8IK@:@G8EKJ LE;<IN<EK K?<@I K?<I8GP
8>8@E K?< :?8E><; 9<?8M@FLI I<KLIE<;
5. Discussion
-<M<I8C P<8IJ 8=K<I 8I@E8 .<EE>8IK F9J<IM<; KNF ;@JK@E:KCP ;@==<I<EK
I<:I<8K@FE8C N8CBJ @E CE8IG ,<?89@C@K8K@FE !8I;<E <OKIFM<IK<; 8E; @E
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:FLC; 9< F9J<IM<; @E K?@J JKL;P #K N8J EFK K?< F9J<IM<IJ F9A<:K@M<
KF @;<EK@=P K?<J< KPG<J F= N8CBJ 8J K?< F9J<IM<I NFLC; =F:LJ FE K?<
I<?89@C@K8K@FE >8I;<EJ =LE:K@FE @E K?< K?<I8G<LK@: GIF>I8D "FN<M<I
K?<J< I<:I<8K@FE8C N8CBJ :FLC; @E K?@J JKL;P 9< C@EB<; KF KNF ;@==<I<EK
KI<8KD<EKJ @E K?< >8I;<E 9P G?PJ@FK?<I8G@JK 8E; GJP:?FK?<I8G@JK 1?<E
K?<J< K?<I8G@JKJ ?8; M8:8K@FE 8E; K?<J< KPG<J F= KI<8KD<EKJ N<I< EFK
:8II@<; FLK @E K?< >8I;<E E<@K?<I F= K?< KNF KPG<J F= N8CBJ :FLC; 9< ;@J
:FM<I<;
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@EK<IGI<K<; 8J <OKIFM<IK K?<P N<I< <OKI<D<CP FG<E FLK>F@E> 8E; :FE
K8:KJ<<B@E> .?<P I8K?<I @E;@J:I@D@E8K<CP 8GGIF8:?<; FK?<I G<FGC< @E
K?< >8I;<E @E FI;<I KF @E@K@8K< :FEM<IJ8K@FE .?@J :8E 9< @EK<IGI<K<; 8J
K?< G8IK@:@G8EKJ 9<:FD@E> DFI< C@M<CP <E<I><K@: 8E; JKI<ELFLJ 9LK :8E
8CJF 9< @EK<IGI<K<; 8J K?<D 8GG<8I@E> I<JKC<JJ 8E; UCC<; N@K? <DFK@FEJ
K?< C8KK<I 9<:8LJ< K?<P F=K<E =<CK G8E>J F= ?LE><I FI K?@IJK N?@:? <>
I<JLCK<; @E JDFB@E> :@>8I<KK<J FI JL:B@E> G8JK@CC<J .?<J< JKIFE> =<<C@E>J
J<<D KF 9< ;@=U:LCK KF ?8I9FLI 8CFE< .?<P :8E 9< @EK<IGI<K<; 8J <OGI<J
J@FEJ F= E<IMFLJE<JJ 8>@K8K@FE FI :FE:<IE #K ;F<J EFK D<8E K?8K K?@J @J
JFD<K?@E> E<>8K@M< 9LK :8E 9< @EK<IGI<K<; 8J <DFK@FEJ K?8K 8I< ;@=U:LCK
KF :FG< N@K? 8CFE< 3FL E<<; KF 9< @E KFL:? N@K? FK?<IJ
#E :FEKI8JK G8IK@:@G8EKJ N?F I<:<@M<; G?PJ@FK?<I8GP ?8; 8 9<?8M
@FLI K?8K :8E 9< @EK<IGI<K<; 8J @EKIFM<IK K?<P N<I< <DFK@FE8C 9LK
JK@CC M<IP :8CD 8E; =I@<E;CP 8=K<I K?< KI<8KD<EK #DD<;@8K<CP 8=K<IN8I;J
K?<P 8GG<8I<; KF 9< DFM<; JFD<K@D<J N@K? K<8IJ @E K?<@I <P<J LI@E>
K?< UIJK D@E 8=K<I K?<I8GP K?<P J<<D<; KF 9< @E 8 9L99C< CFFB
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UNCORRECTED PROOF
A.A. Adevi et al. Urban Forestry & Urban Greening xxx (2018) xxx-xxx
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5.2. Possible link between physiotherapy and the emotional tone in the
garden?
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
UNCORRECTED PROOF
A.A. Adevi et al. Urban Forestry & Urban Greening xxx (2018) xxx-xxx
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6. Conclusion
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Con'icts of interest
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Author contributions
@IJK 8LK?FI =FIDLC8K<; K?< I<J<8I:? HL<JK@FE 8E; @E@K@8K<; K?< JKL;P
KF><K?<I N@K? K?< K?@I; 8LK?FI @IJK 8LK?FI D8;< K?< F9J<IM8K@FEJ @E K?<
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Acknowledgments
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References
;<M@  &@<9<I> '  -KI<JJ I<?89@C@K8K@FE K?IFL>? >8I;<E K?<I8GP 8 :8I<>@M<I
G<IJG<:K@M< FE =8:KFIJ :FEJ@;<I<; DFJK <JJ<EK@8C KF K?< I<:FM<IP GIF:<JJ /I98E FI
/I98E !I<<E  T
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
UNCORRECTED PROOF
A.A. Adevi et al. Urban Forestry & Urban Greening xxx (2018) xxx-xxx
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... NBIs are programs and activities where individuals engage with natural environments with the aim of improving their health and wellbeing (Shanahan et al., 2019;Wilkie and Davinson, 2021). NBIs vary from nature walking groups (Marselle et al., 2019), rehabilitation gardens (Adevi et al., 2018) and forest bathing (Ideno et al., 2017), to community gardening (Howarth et al., 2020), nature conservation, (Richardson et al., 2020) and talking therapy delivered in a natural setting (Cooley et al., 2020). Contact with nature and health have been linked in three interconnected domainsreducing harm from exposure to environmental hazards such as heat; restoring capacities diminished by stress and constant stimuli; and building new capacities such as facilitating social interactions (Markevych et al., 2017). ...
... Nature contact is also associated with reduction in symptoms of depression and anxiety (Bloomfield, 2017;Maund et al., 2019, Nguyen et al., 2022, improvements in sleep, memory, cognition, and attention (Berto, 2014;Bratman et al., 2015;Sia et al., 2020), lower stress levels (Corazon et al., 2018, Shuda et al., 2020, van den Berg and Beute, 2021, and can serve as a pathway to recovery from sexual assault (Moore et al., 2022). Nature's qualities such as ``the views, the smells, the sense of `being there' and sense of place'' (Sempik and Bragg, 2016, p. 101) permit and enable individuals to process their thoughts and emotions nonverbally, which is especially important for people receiving mental health services who are unresponsive to traditional therapeutic settings (Adevi et al., 2018). Nature contact has also been linked with lower incidence of loneliness (Astell-Burt et al., 2022a;Astell-Burt et al., 2022b;Maas et al., 2009). ...
... Despite reasonably clear evidence of mental health benefit and now demonstrably strong interest in NBIs among people experiencing high psychological distress, loneliness, burnout and poor sleep (Astell-Burt et al., 2023), few studies have been conducted with people who have diagnosed mental illnesses (Adevi et al., 2018;Picton et al., 2018). A recent study in Australia demonstrated that mental health clinicians were supportive of and willing to recommend NBIs as they believed that it would enhance the mental wellbeing, social connections, mindfulness, and relaxation of those people using the services (Tambyah et al., 2022). ...
... ICAP-H stress and depression. The theory of a supportive environment was used in both garden design and therapeutic treatment theory [2]. Similar hot springs can be found in other locations, most notably in Cibuni Rengganis, West Java, where the design of the location was inspired by the idea of healing space. ...
Article
Many people prefer to stay close to the nature and enjoy its beauty to boost their psychological well-being. It is also common among college students whose lives are very likely full of stress due to the academic pressure, high expectations, and developmental tasks-related problems as someone who is in a transition between adolescent and adult, and other possible factors. Recently, there has been a development of technology called virtual reality which is a simulated experience that gives users an immersive feel of a virtual world. The purpose of this study was to determine the effect of using virtual reality by presenting videos of natural scenery on college student’s psychological well-being. Two experimental studies using controlgroup design were conducted. Each experiment measured the impact on one variable, and thus each used measurement that matched with each aim. There were 40 students in total. Data were analyzed using the Wilcoxon test followed by the Mann–Whitney test. The result demonstrated that the presentation of natural scenery through virtual reality could increase positive effect although it does not have a significant impact on students’ psychological well-being. Therefore, it provides evidence of the positive impact of living harmoniously with the nature, even if it is through an artificial scenery. Keywords: virtual reality, nature relaxation, positive effect, psychological well-being, student
... Table S1: Systematic review spreadsheet (Supplementary Materials S1). References [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] Funding: The authors would like to thank the Coordenaçao de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES)-Finance Code 001, Pontifical Catholic University of Rio de Janeiro, and Instituto Brasileiro de Jardins Terapêuticos for the financial support we received in carrying out this work. Helena Carla Pimentel is the founder of Instituto Brasileiro de Jardins Terapêuticos -www.ibjardinsterapeuticos.com.br. ...
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Using nature to address socio-environmental challenges has emerged as a promising alternative to improve human well-being. Therapeutic gardens are landscaped outdoor spaces in health institutions, squares, and schools developed to improve the well-being of their users. However, there are information gaps on how to implement them. This study aims to systematize information about therapeutic gardens and use it to develop recommendations for implementing these spaces. We conducted a systematic review, which included 27 studies that contained the words therapeutic gardens, design, and/or implementation. The results indicated that the topic does not have a constant number of publications. Most articles are case studies in Europe (n = 8) and published in journals about environmental and health issues (n = 25). Furthermore, most studies (n = 23) relate the implementation of therapeutic gardens to health institutions. A framework with seven stages of recommendations was developed to guide the implementation and monitoring of these gardens in different spaces. This study is expected to contribute to the development of therapeutic gardens with an interdisciplinary team, promote SDG 3 (good health and well-being), and, mainly, improve the well-being of users.
... Furthermore, the ability to see or experience green space also reduces domestic violence, quickens healing times, reduces stress, improves physical health, and effectuates cognitive and psychological benefits (Sullivan & Kuo 1996). Naturalbased therapy and horticultural therapy have been proven to significantly enhance recovery of both cognitive abilities and levels of stress (Adevi et al. 2018). Qualitative studies (see Grahn et al. 2010;Sahlin et al. 2012) have revealed that clients health and well-being improved when therapy sessions were carried out in rehabilitation gardens. ...
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Background: There is mounting empirical evidence that interacting with nature delivers measurable benefits to people which include physical health, cognitive performance, and psychological well-being.Aim: This study aimed at understanding and exploring how the power of nature and colleagues and principal support assist teachers to adapt and cope with stressors.Setting: The study was conducted in a private high school that uses the Cambridge Curriculum. Most of the students are from middle- and high-income households in the Roodepoort and Honeydew suburbs. Three male and eight female teachers participated in this study, with a mean age of 27 years and an age range between 24 years to 52 years. All the teachers were white, and they taught various subjects and they do not profess any particular religion.Methods: The study adopted a generic explorative qualitative design. Data were collected using semi-structured interviews and incomplete sentences. Data were analysed using content analysis to arrive at the themes.Results: The themes that emerged during data analysis pointed out two major protective factors that enable teachers in this school to adapt and cope resiliently - the power of nature that surrounds the school (green space) and the principal and colleagues’ support in the school.Conclusion: Natural beauty that surrounds the school that resembled a park, as well as support of the principal and colleagues contributes teacher resilience in the school.Contribution: The findings from the study pointed out how school principal and colleagues could support teachers to cope and adapt to stressors, particularly the garden.
... The construction of hospital healing gardens has been shown not only to be beneficial for the physical and mental rehabilitation of patients but also to play a positive role in relieving pressure on medical personnel and the family members of patients (24,25). Accordingly, scholars have begun to explore the mechanism and development of healing processes in healing gardens (26), to compare research processes in relation to healing landscape theory in different countries (27) and to emphasise the conservation of biodiversity in healing gardens (28). ...
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Introduction Hospital affiliated green spaces can help patients recover and recover their physical functions, promote physical and mental relaxation, enhance health awareness, and improve overall health. However, there are still significant questions about how to scientifically construct hospital affiliated green spaces. This study examines the impact of hospital green spaces on patient rehabilitation through scientific evaluation methods, providing reference for the scientific construction of hospital affiliated green spaces. Applicability evaluation was conducted on the affiliated green spaces of three hospitals in Harbin. An evaluation system covering plants, space, accessibility, rehabilitation functions, and promotional and educational functions has been constructed. The entropy weight method is used to determine the weight of indicators, and the grey correlation analysis method is used to evaluate the suitability of green space for patient rehabilitation. Methods The experimental results showed that the landscape accessibility index had the highest weight (0.3005) and the plant index had the lowest weight (0.1628), indicating that caring for special needs is the foundation of hospital landscapes, and plants have subtle and long-term effects on physical and mental health. In the evaluation of the rehabilitation applicability of the affiliated green spaces of various hospitals, the second hospital has the highest grey correlation degree (0.8525), followed by the tumor hospital (0.5306) and the fifth hospital (0.4846). It can be seen that the green space of the second hospital has high applicability for patient rehabilitation, but the green space of the tumor hospital and the fifth hospital needs to be improved and developed. Results and discussion The evaluation criteria used in this study are comprehensive. The landscaping at the Third Hospital is well-planned with good plant configuration and reasonable spatial layout. However, there is insufficient consideration for accessibility in the landscape design, and the details are lacking. The rehabilitation and educational functions of the landscape are inadequate, with limited outdoor activities and low road safety. The hospital′s affiliated green spaces should adhere to the principle of “appropriate scale, comprehensive functionality, and educational leisure,” integrating rehabilitation and educational functions while increasing the variety of outdoor activities. In the future, emphasis should be placed on exploring the integration of landscape and rehabilitation to provide a functional site that is convenient for visiting, with improved rehabilitation facilities and an educational and enjoyable environment. The design should incorporate elements that contribute to a sense of well-being, including roads and
... Engaging in therapeutic work outdoors offers an alternative for patients who find indoor sessions too formal, intimidating and/or anxiety provoking (Jordan andMarshall 2010, Cooley andRobertson 2020). Outdoor clinical sessions enable people to process their thoughts and emotions non-verbally (Adevi et al 2018), give them a greater sense of ownership of the sessions and provide an escape from daily routines and environments . These factors are important when working with people with severe and enduring mental health issues, as research has shown that it can be challenging to engage them in longer-term interventions (Dixon et al 2016, Melamed et al 2019. ...
Article
There is growing interest in outdoor therapy sessions, which appear to have physical and mental health benefits, but there is still a lack of research in this area. A service evaluation was undertaken in a community rehabilitation service to explore the perspectives of service users and staff on outdoor clinical sessions. The rehabilitation team members work with people with severe and enduring mental health issues towards community reintegration. All participants had positive views of outdoor sessions, which were described as supporting people to overcome anxiety, develop confidence and reconnect with the community. Suggestions on how to improve the sessions included staff training and allocating more time. Difficulties included the unpredictability of the environment, logistical barriers and maintaining confidentiality.
... As an addition, or alternative, to the offer of prescribed nature visits, it may be possible to weave opportunities to engage with nature therapeutically throughout the care pathway and explore interactions between formal therapies and nature exposure (Adevi et al., 2018). For example, one participant described how they reg- ...
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The majority of research into the mental health benefits of blue space (outdoor places where water is a central feature) has focussed on the associations between neighbourhood exposure to these spaces and population‐level incidence of unipolar depression or anxiety disorder. There has been little exploration of the therapeutic use of blue space by those navigating bipolar, schizophrenia or other psychotic conditions. Knowledge arising from such an exploration could assist in the design and optimisation of nature‐based care for people with these conditions, as well as with self‐management. We conducted semi‐structured online and telephone interviews with 19 adults who self‐reported experience of these conditions. Interviews were conducted in the United Kingdom from August to December 2021. We describe four of the key interpretive themes identified via an in‐depth inductive thematic analysis of the interview transcripts to highlight how participants sought out moments of affective sanctuary through their blue encounters. Blue spaces were described as having the potential to reset the mind, emotions and body. This was in part due to their socially undemanding nature, and ability to provide respite from a socially stressful world. Participants described developing a blue identity, whereby a sense of attachment to and shared history with these places was articulated as well as incorporating blue spaces into self‐ and emotion‐regulation practices. Finally, participants described experiences of and recommendations for a therapeutic blue intervention. The role of biodiversity in contributing to the benefits of blue spaces was implied primarily in terms of perceived soundscapes, but also through visual observations. Synthesis and applications . Blue care for people with bipolar, schizophrenia or other psychotic conditions should consider the need that some individuals have for solitude and proximity to their home when they visit blue spaces, as well as individual differences in the features of blue space interactions that provide the greatest benefit. Read the free Plain Language Summary for this article on the Journal blog.
... They can activate emotional healing by allowing individuals to process their thoughts and emotions nonverbally as they communicate with nature through their senses [36]. Nature exposure has also been linked with lower incidence of loneliness [37,38]. When offered in groups, NBIs created opportunities for social connections alleviating loneliness [26] which is one of the main indicators of mental and social wellbeing [39]. ...
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Background: Mental health conditions are one of the largest burdens of disease in Australia and globally. There is a need to seek innovative and alternative interventions that can prevent and alleviate mental health symptoms. Nature-based interventions (NBIs), namely programs and activities where individuals engage with natural environments with the aim of improving their health and wellbeing (e.g., nature walking groups), may be such an alternative. This study aimed to explore the perceptions of mental health clinicians on the potential benefits of, and barriers to, implementing NBIs within a community mental health setting. Methods: This study used a qualitative, exploratory research design. Fifteen mental health clinicians were recruited from the Illawarra Shoalhaven Local Health District, Australia, and interviewed (September-October 2021) about their perceptions of NBIs within mental health settings. The semi-structured interviews were analysed using an inductive thematic approach and managed with NVivo. Results: Mental health clinicians viewed spending time in nature as relaxing, refreshing, and therapeutic. Many described it as part of their lifestyle and encouraged consumers to engage in nature-based activities on their own time. If NBIs were to be introduced as part of mental health services, clinicians expressed willingness to promote to with their consumers. Clinicians listed many potential benefits of NBIs for mental health consumers including improved mood, calmness and relaxation, a sense of empowerment, and social connections. Despite these benefits, clinicians were concerned about a variety of barriers to NBIs including consumers’ mental health symptoms such as anxiety or lack of motivation, scepticism, and geographic accessibility, as well as organisational barriers such as policies around safety risk. Conclusion: Responding to the individual and organisational factors that could hinder the implementation of NBIs while building on the existing evidence of the positive impact of nature on health and wellbeing and, as demonstrated in this study, mental health clinicians’ interest and supportiveness of NBIs, mental health services should consider the implementation of NBIs as part of routine practice.
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